DNA methylation risk score for type 2 diabetes is associated with gestational diabetes.

BACKGROUND: Gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) share many pathophysiological factors including genetics, but whether epigenetic marks are shared is unknown. We aimed to test whether a DNA methylation risk score (MRS) for T2DM was associated with GDM across ancestry and GDM criteria. METHODS: In two independent pregnancy cohorts, EPIPREG (n = 480) and EPIDG (n = 32), DNA methylation in peripheral blood leukocytes was measured at a gestational age of 28 ± 2. We constructed an MRS in EPIPREG and EPIDG based on CpG hits from a published epigenome-wide association study (EWAS) of T2DM. RESULTS: With mixed models logistic regression of EPIPREG and EPIDG, MRS for T2DM was associated with GDM: odd ratio (OR)[95% CI]: 1.3 [1.1-1.8], P = 0.002 for the unadjusted model, and 1.4 [1.1-1.7], P = 0.00014 for a model adjusted by age, pre-pregnant BMI, family history of diabetes and smoking status. Also, we found 6 CpGs through a meta-analysis (cg14020176, cg22650271, cg14870271, cg27243685, cg06378491, cg25130381) associated with GDM, and some of their methylation quantitative loci (mQTLs) were related to T2DM and GDM. CONCLUSION: For the first time, we show that DNA methylation marks for T2DM are also associated with GDM, suggesting shared epigenetic mechanisms between GDM and T2DM.

Características de la infección por SARS-CoV-2 en niños y adolescentes asistidos durante el primer año de la pandemia en un prestador privado de salud de Montevideo / Characteristics of the SARS-CoV-2 infection during the first year of the pandemic in children and adolescents assisted at a private health provider in Montevideo / Características da infecção por SARS-CoV-2 em crianças e adolescentes durante o primeiro ano da pandemia atendidas por uma assistência de saúde privada em Montevidéu

Introducción: las infecciones respiratorias agudas virales suelen ser más frecuentes en niños que en adultos. Sin embargo, en el caso de la COVID-19 la mayoría de los casos pediátricos son leves o asintomáticos. Objetivo: describir las características clínicas y epidemiológicas de los niños con COVID-19 asistidos en un prestador de salud de Montevideo durante el primer año de la pandemia. Material y métodos: estudio descriptivo retrospectivo. Inclusión: pacientes menores de 15 años con reacción en cadena de la polimerasa en tiempo real (RT-PCR) positiva para SARS-CoV-2 entre el 13/3/2020 y el 31/03/2021. Principales variables: sintomatología, comorbilidades, nexo epidemiológico y generación de casos secundarios. Resultados: se realizaron 6.642 RT-PCR para SARS-CoV-2, 486 fueron positivas (7%). El 94% se diagnosticaron entre 12/2020 y 3/2021. Los síntomas respiratorios fueron los más frecuentes en el 98% de los casos sintomáticos. Un 60% presentaron fiebre. El 94% habían tenido contacto con un caso confirmado de COVID-19, 57% intradomiciliario, 31% en centro educativo, y 10% en actividades sociales. El 86% de los contactos eran adultos. Doscientos quince niños fueron el caso índice en el hogar y 73 (34%) generaron casos secundarios intradomiciliarios. Conclusiones: los resultados describen la situación clínica y epidemiológica de una población pediátrica de Montevideo durante el primer año de la pandemia. Dado los cambios constantes en la dinámica de transmisión y de casos es necesario continuar con la vigilancia y realización de este tipo de estudios para ajustar las definiciones de caso sospechoso y racionalizar la indicación de testeo.

Introduction: viral acute respiratory infections are usually more frequent and severe in children than in adults. However, in the case of COVID-19, most pediatric cases are mild or asymptomatic. Objective: describe the clinical and epidemiological characteristics of children with COVID-19 assisted by a health provider in Montevideo, during the first year of the pandemic. Materials and methods: retrospective descriptive study. Sample: patients under 15 years of age with positive RT-PCR for SARS-CoV-2 between 3/13/2020-03/31/2021. Main variables: symptomatology, comorbidities, epidemiological link and generation of secondary cases. Results: 6,642 RT-PCR tests were performed for SARS-CoV-2, 486 positive (7%). 94% were diagnosed between 12/2020 and 3/2021. Respiratory symptoms were the most frequent in 98% of symptomatic cases. 60% had fever. 94% had had contact with a confirmed case of COVID-19, 57% intra-domiciliary, 31% at educational centers, and 10% got infected during social activities. 86% of the contacts were adults. Two hundred and fifteen children were the initial case at the household and 73 (34%) generated secondary intra-domiciliary cases. Conclusions: the results describe the clinical and epidemiological situation of a pediatric population in Montevideo during the first year of the pandemic. Given the constant changes in the transmission dynamics and cases, it is necessary to continue to monitor and perform this type of study to adjust the definitions of suspected cases and rationalize testing prescriptions.

Introdução: as infecções respiratórias virais agudas são, geralmente, mais frequentes e graves em crianças do que em adultos. No entanto, no caso da COVID-19, a maioria dos casos pediátricos é leve ou assintomática. Objetivo: descrever as características clínicas e epidemiológicas de crianças com COVID-19 atendidas por uma Assistência de Saúde em Montevidéu, durante o primeiro ano da pandemia. Materiais e métodos: estudo descritivo retrospectivo. Amostra: pacientes menores de 15 anos de idade com RT-PCR positivo para SARS- CoV-2 entre 13/03/2020-31/03/2021. Variáveis principais: sintomatologia, comorbidades, vínculo epidemiológico e geração de casos secundários. Resultados: 6.642 RT-PCR foram realizados para SARS- CoV-2, 486 positivos (7%). 94% foram diagnosticados entre 12/2020 e 3/2021. Os sintomas respiratórios foram os mais frequentes em 98% dos casos sintomáticos. 60% tiveram febre. 94% tiveram contato com caso confirmado de COVID-19, 57% intradomiciliar, 31% em centros educacionais e 10% durante atividades sociais. 86% dos contatos foram adultos. Duzentas e quinze crianças foram o caso inicial do lar e 73 (34%) geraram casos secundários intradomiciliares. Conclusões: os resultados descrevem a situação clínica e epidemiológica de uma população pediátrica em Montevidéu durante o primeiro ano da pandemia. Dadas as constantes mudanças na dinâmica de transmissão e de casos, é necessário continuar monitorando e realizando esse tipo de estudo para ajustar as definições de casos suspeitos e racionalizar a indicação de testagem.

Antibiotic susceptibility and fosfomycin resistance characterization in a cohort of children older than 6 years of age with urinary tract infection / Sensibilidad antibiótica y caracterización de la resistencia a fosfomicina en una cohorte de niños mayores de 6 años con infección urinaria

Fosfomycin tromethamol (FT) was reintroduced as an option for the treatment of low urinary tract infection (UTI) in children. In this study, we described the antibiotic sensitivity and mechanisms of resistance to fosfomycin in isolates from children older than 6 years with UTI. Urine culture and antibiotic susceptibility study were performed. In fosfomycin resistant strains, PCR for fos, blaCTX-M was performed followed by classification by phylogenetic group and sequencetyping. Escherichia coli was the most frequent etiological agent (89.2%). The susceptibility percentages were: fosfomycin 97.9%; amoxicillin-clavulanate 92.7%; cefuroxime and ceftriaxone 99%; nitrofurantoin 94.4%. An E. coli strain (ST69, phylogenetic group D) was resistant to fosfomycin (MIC 256mg/l) and carried the blaCTX-M-14 and fosA3 genes in a 45kb IncN-type plasmid.

La fosfomicina-trometamol (FT) se reintrodujo como una opción para el tratamiento de la infección del tracto urinario (ITU) baja en niños. En este estudio describimos la sensibilidad antibiótica y los mecanismos de resistencia a FT en aislamientos de niños mayores de 6 anos con ITU. Se realizaron urocultivos y estudios de sensibilidad antibiótica. En las cepas resistentes a fosfomicina se realizó la técnica de PCR para fos, blaCTX-M, y su identificación según su grupo filogenéticoy secuenciotipo. Escherichiacoli fue el agente etiológico más frecuente (89,2%). Los porcentajes de sensibilidad fueron: fosfomicina 97,9%; amoxicilina-clavulánico 92,7%; cefurox-ima y ceftriaxona 99%; nitrofurantoína 94,9%. Una cepa de E. coli (ST69, grupo filogenético D) fue resistente a fosfomicina (CIM 256mg/l) y portaba los genes blaCTX-M-14 y fosA3 en un plás-mido de 45 kb del tipo IncN. Este es el primer reporte de E. coli ST69 con blaCTX-M-14/fosA3 de origen humano.

Effects of Moringa oleifera Lam. Supplementation on Inflammatory and Cardiometabolic Markers in Subjects with Prediabetes.

Different parts of the Moringa oleifera Lam. (MO) tree are consumed as food or food supplements for their nutritional and medicinal value; however, very few human studies have been published on the topic. The current work was aimed to provide ancillary analysis to the antidiabetic effects previously reported in a double-blind, randomized, placebo-controlled, parallel group intervention conducted in patients with prediabetes. Thus, the effect of MO leaves on blood and fecal inflammatory markers, serum lipid profile, plasma antioxidant capacity and blood pressure was studied in participants who consumed 6 × 400 mg capsule/day of MO dry leaf powder (MO, n = 31) or placebo (PLC, n = 34) over 12 weeks. Differences between groups were assessed using each biomarker's change score with, adjustment for fat status and the baseline value. In addition, a decision tree analysis was performed to find individual characteristics influencing the glycemic response to MO supplementation. No differences in the biomarker's change scores were found between the groups; however, the decision tree analysis revealed that plasma TNF-α was a significant predictor of the subject's HbA1c response (improvement YES/NO; 77% correct classification) in the MO group. In conclusion, TNF-α seems to be a key factor to identify potential respondents to MO leaf powder.

Addition of intermittently scanned continuous glucose monitoring to standard care in a cohort of pregnant women with type 1 diabetes: effect on glycaemic control and pregnancy outcomes.

AIMS/HYPOTHESIS: The aim of this study was to assess whether the addition of intermittently scanned continuous glucose monitoring (isCGM) to standard care (self-monitoring of blood glucose [SMBG] alone) improves glycaemic control and pregnancy outcomes in women with type 1 diabetes and multiple daily injections. METHODS: This was a multicentre observational cohort study of 300 pregnant women with type 1 diabetes in Spain, including 168 women using SMBG (standard care) and 132 women using isCGM in addition to standard care. In addition to HbA1c, the time in range (TIR), time below range (TBR) and time above range (TAR) with regard to the pregnancy glucose target range (3.5-7.8 mmol/l) were also evaluated in women using isCGM. Logistic regression models were performed for adverse pregnancy outcomes adjusted for baseline maternal characteristics and centre. RESULTS: The isCGM group had a lower median HbA1c in the second trimester than the SMBG group (41.0 [IQR 35.5-46.4] vs 43.2 [IQR 37.7-47.5] mmol/mol, 5.9% [IQR 5.4-6.4%] vs 6.1% [IQR 5.6-6.5%]; p=0.034), with no differences between the groups in the other trimesters (SMBG vs isCGM: first trimester 47.5 [IQR 42.1-54.1] vs 45.9 [IQR 39.9-51.9] mmol/mol, 6.5% [IQR 6.0-7.1%] vs 6.4% [IQR 5.8-6.9%]; third trimester 43.2 [IQR 39.9-47.5] vs 43.2 [IQR 39.9-47.5] mmol/mol, 6.1% [IQR 5.8-6.5%] vs 6.1% [IQR 5.7-6.5%]). The whole cohort showed a slight increase in HbA1c from the second to the third trimester, with a significantly higher rise in the isCGM group than in the SMBG group (median difference 2.2 vs 1.1 mmol/mol [0.2% vs 0.1%]; p=0.033). Regarding neonatal outcomes, newborns of women using isCGM were more likely to have neonatal hypoglycaemia than newborns of non-sensor users (27.4% vs 19.1%; ORadjusted 2.20 [95% CI 1.14, 4.30]), whereas there were no differences between the groups in large-for-gestational-age (LGA) infants (40.6% vs 45.1%; ORadjusted 0.73 [95% CI 0.42, 1.25]), Caesarean section (57.6% vs 48.8%; ORadjusted 1.33 [95% CI 0.78, 2.27]) or prematurity (27.3% vs 24.8%; ORadjusted 1.05 [95% CI 0.55, 1.99]) in the adjusted models. A sensitivity analysis in pregnancies without LGA infants or prematurity also showed that the use of isCGM was associated with a higher risk of neonatal hypoglycaemia (non-LGA: ORadjusted 2.63 [95% CI 1.01, 6.91]; non-prematurity: ORadjusted 2.52 [95% CI 1.12, 5.67]). For isCGM users, the risk of delivering an LGA infant was associated with TIR, TAR and TBR in the second trimester in the logistic regression analysis. CONCLUSIONS/INTERPRETATION: isCGM use provided an initial improvement in glycaemic control that was not sustained. Furthermore, offspring of isCGM users were more likely to have neonatal hypoglycaemia, with similar rates of macrosomia and prematurity to those of women receiving standard care.

Moringa oleifera Leaf Supplementation as a Glycemic Control Strategy in Subjects with Prediabetes.

Moringa oleifera (MO) is a multipurpose plant with a high polyphenol content, which is being increasingly consumed to lessen the risk of chronic metabolic diseases such as Type 2 diabetes; however, scientific evidence from clinical trials is scarce. A double-blind, randomized, placebo-controlled, parallel group intervention study with MO leaves as a food supplement was conducted in subjects with prediabetes. They consumed six daily capsules of MO dry leaf powder (2400 mg/day) (MO, n = 31) or placebo (PLC, n = 34) over 12 weeks. Glycemia, appetite-controlling hormones and gut microbiota composition were studied. ANCOVA with the fixed factor "treatment" and the basal value as covariate was used to compare the change score between the groups. The results showed significant differences between groups in the rate of change of fasting blood glucose (FBG) and glycated hemoglobin (HbA1c), which showed opposite directions during the intervention, decreasing in MO and increasing in PLC. No different change scores were found between the groups in microbiota, hepatic and renal function markers or the appetite-controlling hormones measured. In conclusion, MO supplementation resulted in favorable changes in glycaemia markers compared to placebo in the subjects with prediabetes studied, suggesting that MO might act as a natural antihyperglycemic agent.

Expert Study: Utility of an Automated Bolus Advisor System in Patients with Type 1 Diabetes Treated with Multiple Daily Injections of Insulin-A Crossover Study.

OBJECTIVE: This study was designed to assess the impact of the use of an automated bolus advisor (ABA) on glycemic control, quality of life, and satisfaction in adult patients with type 1 diabetes mellitus treated with multiple daily injections of insulin. MATERIALS AND METHODS: A crossover, prospective, randomized, controlled, multicenter study of 36 weeks duration was conducted. Patients were randomized to start in either control phase (CP) using a traditional blood glucose meter to calculate insulin doses (Accu-Chek(®) Aviva Nano; Roche Diagnostics, Indianapolis, IN) or intervention phase (IP) using an ABA meter (Accu-Chek Aviva Expert; Roche Diagnostics) and switched to the other phase after a washout period. Each phase was 12 weeks in duration. RESULTS: Significant glycated hemoglobin (HbA1c) reduction was observed in both phases (CP, initial HbA1c of 8.05 ± 0.7%, final HbA1c of 7.59 ± 0.7% [P < 0.001]; IP, initial HbA1c of 8.13 ± 1%, final HbA1c of 7.61 ± 0.8% [P < 0.001]). Although the trend was to a higher HbA1c reduction in IP, no statistically significant differences were observed between phases (CP, HbA1c -0.39%; IP, HbA1c -0.52% [P = 0.8]). During IP, the number of daily glucose measurements was greater (4.28 ± 1.2 vs. 4.01 ± 1.1 [P < 0.006]), the rate of postprandial hypoglycemia was lower, and an improvement in quality of life and higher satisfaction were observed. CONCLUSIONS: In this first crossover study comparing the use of an ABA with the standard usual care, the use of an ABA was effective and well accepted. Furthermore, reduction in hypoglycemic events, improvement in adherence and quality of life, and higher treatment satisfaction were observed.

Actualización del diagnóstico de situación de la investigación en salud en el ámbito del Ministerio de Salud de la Nación y 19 Ministerios Provinciales / Update of Diagnosis of Health Research Situation in the Field of Argentine National and 19 Provincial Ministries of Health

Dado los escasos antecedentes de estudios sobre los sistemas de investigación para la salud en Argentina, el Ministerio de Salud de la Nación decidió realizar un diagnóstico de las actividades de investigación en el subsector público de salud. OBJETIVO: Describir las actividades de gestión, producción y difusión de la investigación realizadas por los ministerios de Salud y sus organismos dependientes entre 2010 y 2012. MÉTODOS: Estudio descriptivo transversal. Se estudiaron 20 ministerios (Nación, Ciudad Autónoma de Buenos Aires y provincias de Buenos Aires, Córdoba, Chaco, Corrientes, Chubut, Formosa, Jujuy, La Pampa, La Rioja, Mendoza, Misiones, Neuquén, Río Negro, San Juan, Santa Cruz, Santiago del Estero, Tierra del Fuego y Tucumán). Se efectuó una encuesta estructurada a funcionarios responsables de organismos ministeriales de nivel central, descentralizados y servicios de salud. RESULTADOS: Se relevaron 299 organismos y 1.070 investigaciones; el 80% de las cuales se había realizado en servicios de salud. El 61,3% del total recibió financiamiento. CONCLUSIONES: La magnitud de las investigaciones halladas en este estudio evidencia la importancia que las actividades de investigación tienen en los ministerios de Salud estudiados, en consonancia con el apoyo que se le ha dado en los últimos años a esta actividad como política de Estado...

Considering the few background of studies about the health systems in Argentina, the National Ministry of Health decided to make a diagnosis of the research activities in the public health subsector. OBJECTIVE: To describe the activities of research management, production and dissemination conducted by health ministries and their agencies between 2010 and 2012. METHODS: Descriptive cross-sectional study. A total of 20 health ministries (National, Autonomous City of Buenos Aires and the provinces of BuenosAires, Córdoba, Chaco, Corrientes, Chubut, Formosa, Jujuy, La Pampa, La Rioja, Mendoza, Misiones, Neuquén, Río Negro, San Juan, Santa Cruz, Santiago del Estero, Tierra del Fuegoa nd Tucumán) was studied. A structured survey to responsible officials of central level structures, decentralized institutionsand health services was conducted. RESULTS: 299 dependent agencies and 1070 research projects were surveyed, 80% of which had been conducted in health services and 61.3% of total had received financing. CONCLUSIONS: The magnitude of the research found in this study shows the importance that the research activities have in the ministries of health studied, in line with the support that has been given in recent years to this activity as state policy...

Hemoglobin A1c versus oral glucose tolerance test in postpartum diabetes screening.

OBJECTIVE: To determine the usefulness of measuring hemoglobin A(1c) (A1C), alone or combined with the fasting glucose test, compared with the oral glucose tolerance test (OGTT) for the reassessment of the carbohydrate metabolism status in postpartum women with a history of gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS: We evaluated the status of carbohydrate metabolism by performing the OGTT and fasting glucose and A1C tests in 231 postpartum women with prior GDM 1 year after delivery. RESULTS: The prevalence of abnormal carbohydrate metabolism was 45.89% by the OGTT criterion, 19.05% by the A1C test criterion, 38.10% by the fasting glucose test criterion, and 46.75% by the A1C-fasting glucose test criteria. Using the OGTT as the gold standard, abnormal carbohydrate metabolism according to the A1C test criterion had 22.64% sensitivity and 54.55% positive predictive value; abnormal carbohydrate metabolism by the fasting glucose criterion had 83.02% sensitivity and 100% positive predictive value. The A1C-fasting glucose test criteria classified 18 women with normal carbohydrate metabolism as having abnormal carbohydrate metabolism. Abnormal carbohydrate metabolism by the A1C-fasting glucose test criteria had 83.02% sensitivity and 81.48% positive predictive value. CONCLUSIONS: Our results seem to indicate that the A1C test criterion alone or in combination with fasting glucose test criterion does not provide a sensitive and specific diagnosis of abnormal carbohydrate metabolism in women who have had GDM.

[Is it necessary to know which workers are carriers of MRSA in contact with cancer patients?]. / ¿Es necesario conocer qué trabajadores son portadores de SARM en contacto con enfermos oncológicos?

Our objective was to determine the prevalence of methicillin-resistant Staphylococcus aureus in workers who had direct contact with oncologic patients infected with MRSA and admitted to the intensive care unit of the Valencian Institute of Oncology. A study of prevalence of MRSA colonization of 62 workers was performed. Samples were taken from nose and pharynx in each of the workers. After 24 hours of incubation in Amies transport medium Viscose (Eurotubo®), 124 samples were seeded (N = 124) in chocolate agar agar, MRSA II and BHI broth (Brain Heart Infusion). Those colonies that were identified by Gram stain gram-positive cocci in clusters available, catalase positive and coagulase positive were processed for study of sensitivity by Kirby-Bauer method and screening test for methicillin (10µg of Oxoid®) on Mueller-Hinton (Becton-Dickinson®, BD), supplemented with NaCl (2%). Those confirmed MRSA isolates, he returned to perform sensitivity study by microdilution (MicroScan®, Siemens) to determine the MIC (mg/L). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was 1.61% (1) and 12.90% (8) for methicillin-sensitive Staphylococcus aureus (MSSA), from nostrils. The measures implemented were: nasal application of mupirocin to the worker colonized control isolation measures in infected patients and indoctrination of the personnel involved.

Compresión extrinseca del esófago por trayecto anomalo de la aorta: presentación de un caso / Compression extrinsic of the esophagus for trayect abnormalities of the aorta: presentation of a case

Se presenta el caso del hallazgo incidental de una comprensión extrínseca a nivel de tercio inferior del esófago causado por el trayecto anómalo de la Aorta torácica descendente. Se realiza revisión de la literatura

Causas de enfermedad hepática aguda y crónica en tres consultas de referencia de hepatología en la ciudad de Caracas / Risk of disease hepatic acute and chronic in three consultation of reference of hepatologic in the city of Caracas

Presentamos la prevalencia de Enfermedad Hepática Aguda y Crónica (EHAC) de tres consultas de referencia de la ciudad de Caracas, Venezuela. Nuestro objetivo fue determinar la causa más frecuente de EHAC en nuestro medio. Se obtuvo una muestra de 1812 pacientes de las consultas de Hepatología de dos centros hospitalarios Hospitales del IVSS Domingo Luciani y Pérez Carreño y de uno privado Instituto Médico La Floresta; con criterios clínicos, Bioquímicos, serológicos, de imágenes y algunos histológicos para EAHC. El sexo más frecuente fue el masculino con 55,7 por ciento. La causa más frecuente fue hepatitis viral C predominó con 23,7 por ciento. La segunda causa fue por alcohol con un 12 por ciento de los cuales la infección por virus C estuvo presente en 24 casos

Espacios orofaríngeos y maloclusión esquelética / Oropharyngeal space and skeletal malocclusion

Se realizó un estudio de tipo inductivo y correlacional para observar los espacios orofaríngeos y su relación con la maloclusión esquelética. Se utilizó una muestra inicial de 198 de los pacientes según la maloclusión esquelética y un grupo de 27 pacientes quirúrgicos. Se correlacionaron la edad, el sexo y el tratamiento quirúrgico en cada grupo. Se observó la medida descrita con McNamara, el área orofaríngea superior e inferior. Se aplicaron pruebas estadísticas de distribución, promedios, desviaciones estándar en todos los grupos. Se observó la probabilidad entre géneros, el coeficiente de correlación entre todas las variables y la prueba de error de reproducibilidad. Hubo ausencia de alguna constante entre la maloclusión esquelética y McNamara con el tamaño de los espacios orofaríngeos. Se observó que la relación entre la edad y el espacio orofaríngeo inferior es proporcional en los tres tipos de maloclusiones. En los pacientes quirúrgicos se alteró el espacio orofaríngeo inferior en sentido vertical